385 Plasma Syndecan-1 Levels Identify a Cohort of Patients With Severe Sepsis at a High Risk of Intubation Following Large Volume Intravenous Fluid Resuscitation

Abstract

Sepsis damages the endothelium and extracellular matrix (ECM), contributing to fluid extravasation, acute organ injury, and death. Biomarker-based risk stratification holds promise in identifying those patients who may benefit from restrictive fluid resuscitation strategies. We sought to determine if plasma syndecan–1 levels can predict a cohort at particularly high risk of respiratory failure following intravenous fluid (IVF) administration. Syndecan-1 levels were measured in plasma samples at the time of enrollment. The primary outcome was the difference in syndecan-1 levels in patients intubated versus those not requiring intubation, while secondary outcomes were differences in syndecan-1 based on in-hospital mortality and development of acute kidney injury. A cutoff for high versus low syndecan-1 levels was developed using an ROC curve, and logistic regression was performed to evaluate the risk of intubation associated with administration of IV fluids. Syndecan-1 levels were measured in 175 patients. Fifty two patients (22%) met the primary outcome of intubation, 34 (21%) died, and 100 (57%) developed kidney injury. Levels of syndecan-1 were non-significantly higher in patients who were intubated, and significantly higher in non-survivors and those with kidney injury. High syndecan-1 levels were defined as >240 ng/mL. Median IVF volume administered was 4.0 L (IQR 2.0, 5.3) and was not significantly different between high and low syndecan-1 groups. IVF volume was not associated with risk of intubation in patients with a low syndecan-1 level (p = 0.99), but demonstrated a significant linear relationship with the risk of intubation in patients with high syndecan-1 levels (p < 0.05). These data are represented in Figure 1 as Lowess smoothing plots. Syndecan-1 levels are significantly elevated in ED sepsis non-survivors and non-significantly higher among those requiring intubation. Patients with high syndecan-1 levels may represent a cohort at particular risk for intubation following large volume fluid administration. Further studies to validate these findings in a prospective cohort are indicated.